Understanding the medications that can affect your hearing health
Introduction
Tinnitus—the perception of ringing, buzzing, or hissing in the ears—is a common condition that can significantly impact quality of life. One often-overlooked cause of tinnitus is ototoxicity, a term used to describe ear damage resulting from exposure to certain medications or chemicals. With over 200 known ototoxic substances, it’s crucial to be aware of which medications could potentially harm your hearing and balance. In this comprehensive guide, we’ll delve into the world of ototoxic medications, exploring how they affect the auditory system and providing an extensive list of drugs known to cause ototoxicity.
What Is Ototoxicity?
Ototoxicity refers to the property of being toxic to the ear (oto-), specifically the cochlea or auditory nerve and sometimes the vestibular system, which controls balance. Ototoxic substances can cause temporary or permanent damage, leading to symptoms like tinnitus, hearing loss, and balance disorders. These effects can occur shortly after exposure or develop over time, depending on the dosage and duration of medication use.
How Do Ototoxic Medications Affect the Ear?
Ototoxic medications can damage the sensory hair cells in the cochlea and vestibular system of the inner ear. These hair cells are essential for converting sound vibrations into electrical signals that the brain interprets as sound. Damage to these cells can result in:
- Hearing Loss: Difficulty hearing faint sounds or understanding speech.
- Tinnitus: Ringing, buzzing, or hissing noises in the absence of external sounds.
- Balance Disorders: Dizziness, vertigo, or unsteadiness.
The severity of these symptoms can vary based on individual susceptibility, medication dosage, and concurrent exposure to other ototoxic substances or loud noises.
Extensive List of Known and Potentially Ototoxic Medications
Below is a comprehensive list of medications known or suspected to be ototoxic. It’s important to note that not everyone who takes these medications will experience ototoxic effects, and the benefits of these drugs may outweigh the risks in treating serious conditions. Always consult your healthcare provider before making any changes to your medication regimen.
1. Antibiotics
Aminoglycoside Antibiotics
These are among the most ototoxic medications, often causing irreversible hearing loss.
- Gentamicin
- Neomycin
- Streptomycin
- Amikacin
- Kanamycin
- Tobramycin
- Netilmicin
Macrolide Antibiotics
- Erythromycin
- Azithromycin
- Clarithromycin
Glycopeptide Antibiotics
- Vancomycin
Others
- Minocycline
- Polymyxin B
- Colistin
2. Diuretics
Loop Diuretics
Used to treat hypertension and edema, especially in cases of heart failure.
- Furosemide (Lasix)
- Bumetanide
- Ethacrynic Acid
- Torsemide
3. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
High doses or prolonged use can increase the risk.
- Aspirin (Salicylates)
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Ketoprofen
- Indomethacin
- Diclofenac
4. Chemotherapy Agents
Platinum-Based Chemotherapy
- Cisplatin
- Carboplatin
- Oxaliplatin
Others
- Vincristine
- Vinblastine
- Bleomycin
- Nitrogen Mustard
5. Quinine and Antimalarial Drugs
- Quinine
- Chloroquine
- Hydroxychloroquine (Plaquenil)
6. PDE5 Inhibitors
Used for erectile dysfunction.
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Avanafil (Stendra)
7. Antidepressants
While evidence is mixed, some have reported ototoxic effects.
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Tricyclic Antidepressants (TCAs)
- Amitriptyline
- Nortriptyline
- Venlafaxine (Effexor)
- Bupropion (Wellbutrin)
8. Antihypertensive Drugs
- Beta-blockers
- Atenolol
- Metoprolol
- ACE Inhibitors
- Enalapril
- Lisinopril
9. Anticonvulsants
- Phenytoin (Dilantin)
- Carbamazepine (Tegretol)
- Valproic Acid (Depakote)
10. Antineoplastic Agents
- Methotrexate
- Interferon
11. Anesthetics
- Bupivacaine
- Lidocaine
12. Benzodiazepines
- Diazepam (Valium)
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
13. Cardiovascular Drugs
- Amiodarone
- Digitoxin
14. Heavy Metals
- Lead
- Mercury
- Arsenic
15. Antiseptics and Disinfectants
- Chlorhexidine
- Alcohol (when used in ear preparations)
16. Isotretinoin
- Accutane (used for severe acne)
17. Immunosuppressants
- Cyclosporine
- Tacrolimus
18. Miscellaneous
- Deferoxamine (used in iron poisoning)
- Nitric Oxide (in high concentrations)
- Bismuth (found in some antacids)
Factors Influencing Ototoxicity
Several factors can increase the risk of ototoxicity:
- Dosage and Duration: Higher doses and prolonged use elevate the risk.
- Renal Function: Impaired kidney function can lead to drug accumulation.
- Age: Very young and elderly patients are more susceptible.
- Pre-existing Hearing Loss: Increases vulnerability.
- Concurrent Ototoxic Drugs: Using multiple ototoxic medications simultaneously.
- Genetic Predisposition: Genetic factors can influence susceptibility.
Signs and Symptoms of Ototoxicity
Be vigilant for the following symptoms if you’re taking any of the listed medications:
- Tinnitus: Ringing, buzzing, or hissing sounds.
- Hearing Loss: Difficulty understanding speech, needing higher volumes.
- Vertigo: Spinning sensation or dizziness.
- Balance Problems: Unsteadiness, especially in the dark.
If you notice any of these symptoms, contact your healthcare provider immediately.
Diagnosing Ototoxicity
Audiological Assessments
- Baseline Testing: Prior to starting ototoxic medications, get a comprehensive hearing test.
- Ongoing Monitoring: Regular audiometric evaluations during treatment.
- High-Frequency Audiometry: Sensitive in detecting early ototoxic changes.
- Otoacoustic Emissions (OAEs): Assess cochlear hair cell function.
Vestibular Testing
- Videonystagmography (VNG): Evaluates balance function.
- Rotational Chair Testing
- Posturography
Preventing and Managing Ototoxicity
Before Treatment
- Risk Assessment: Discuss potential ototoxic effects with your doctor.
- Alternative Medications: Explore non-ototoxic options if available.
- Baseline Evaluation: Undergo hearing and balance tests.
During Treatment
- Regular Monitoring: Schedule periodic hearing tests.
- Dose Adjustment: Use the lowest effective dose.
- Hydration: Maintain good kidney function to help excrete drugs.
- Avoid Noise Exposure: Protect ears from loud environments.
After Treatment
- Follow-Up Testing: Continue monitoring hearing and balance post-treatment.
- Rehabilitation: Consider hearing aids or balance therapy if needed.
- Report Symptoms: Keep your healthcare team informed of any changes.
Research and Future Directions
Scientists are investigating protective agents that could prevent or reduce ototoxic damage. Antioxidants like N-acetylcysteine and sodium thiosulfate are being studied for their potential to safeguard the inner ear during treatment with ototoxic drugs like cisplatin. While promising, these interventions are not yet widely available or approved for clinical use.
Conclusion
Awareness is the first line of defense against ototoxicity. By understanding which medications pose a risk and monitoring your hearing and balance, you can take proactive steps to protect your auditory health. Always communicate openly with your healthcare providers about your concerns, and never discontinue or adjust medication without professional guidance.
References
- Asha – The American Speech-Language-Hearing Association
Disclaimer: This article is intended for informational purposes only and should not replace professional medical advice. Always consult your healthcare provider for personalized guidance.
